FAQ FOR PARENTS > 41-50

About one third of patients referred to the Hypospadias Centre had a failed TIP procedure. The concept of the TIP procedure results in leaving a large raw surface in the reconstructed urethra. This raw surface usually contracts during healing resulting in a very narrow urethra and persistent fistula. Occasionally, the whole wound disrupts completely and urine comes out from the original opening. The condition becomes more complicated when the surgeon during the TIP procedure has excised the forskin. This makes the job of correction more difficult as there is no excess skin available to reconstruct the narrow urethra.

A report from Anonymous Patient:

My Life With Hypospadias

The congenital malformation of the urethra is usually surgically corrected in early childhood. I am 28 years old now and I have not undergone this correction. It was not until puberty that I noticed that my penis actually looks slightly different from the other boys’ when the foreskin is retracted. Over time I felt ashamed, afraid of being exposed and did not want to stand in a row next to the others at the urinal. To avoid this I tried to go to the toilet alone or chose the cabin. To be made fun of for sitting down on a toilet while urinating was less annoying than a possible discovery of hypospadias, which caused me constant anxiety. Especially in puberty you don’t want to be “different”. I tried to suppress the malformation and avoided any sexual advances and contacts. It would certainly have been better if I had turned to my parents with this burden, but I was even ashamed to talk to them and did not bring the subject up to them. The repression eventually became part of my every day life, subconsciously rather than self-protecting, because the panic and feeling of being different did affect my psyche.

It was only at the age of 20 that I learned by chance via the Internet that my congenital malformation of the urethra was a so-called hypospadias and that it occurs relatively frequently in newborn boys. The information on surgical corrections was mainly related to infants. Here it was always emphasized that an operation at the age between 12 and 18 months was the most advantageous. I assumed that a successful operative correction in adulthood was not a safe option due to the higher complication rate. I therefore rejected this option for the time being. Nevertheless, I felt better when I realized that I was not the only one who has this congenital malformation and that surgery was basically possible. From this point on, I felt a little safer with hypospadias and dared to allow physical contact. The women I met reacted very differently to hypospadias. I experienced rejection, indifference but also understanding. Nevertheless, getting to know each other is relatively difficult, as the malformation continues to be very unpleasant for me and for this reason I try to find out in advance how this person would react to such malformations. Of course, this does not always work as hoped and oven seems contrived and awkward. A normal, relaxed getting to know each other is not possible for me.

The urethral malformation does not restrict me very much from a purely functional point of view, rather it represents a great psychological strain. Over time it becomes more and more difficult for me to live with it without having worries about it and I do suffer from it. I want a change and so I resumed the research on the topic of hypospadias corrections for adults and came across the website of the hypospadias centre of the Emma Klinik in Seligenstadt. The treatment spectrum on the main page already lists the surgical correction for adults. I arranged an appointment with Prof. Hadidi. Among other things, Prof. Hadidi explained to me straightforwardly and plausibly the possible risks of a surgical correction and seemed very professional to me. Especially the specialization in hypospadias as well as Prof. Hadidi’s expertise in adults and the his international reach have convinced me. I am now awaiting the operation and hope that everything will go well.

Pin point meatus after TIP	more urine from fistula

We tell the parents not to look at the penis for one month after surgery until the swelling disappear and the wound has healed by 70%.

However, the mother should contact the surgeon when the child has severe pain or difficulty to pass urine or can not pass urine for more than 6 hours.

Normally, there is no need to go to your pediatrician regarding the operation. If there is real worry, you need to contact your surgeon.

However, if your son develops fever or other complaints not related to the operation, you should go to your pediatrician as is usually the case.

If your son has no (or little) pain when passing urine and the wound is not very swollen and red, it is almost certain that the fever has nothing to do with the hypospadias operation and you should contact your pediatrician to exclude flu, chest infection, teething…etc.

Professor Hadidi uses very fine absorbable sutures (finer than the human hair) and they dissolve spontaneously between 1-3 months after surgery and there is no need to remove them. However, some of the threads may take longer than that in some patients. This is normal and should not alarm the parents or the patient. It is important not to try to pull them out, as this may interfere with the healing.

As mentioned above, the sutures start to dissolve about one month after surgery. They dissolve by having a chemical reaction. When this occurs, the penis may become red, swollen and small yellow “pustules” may appear. This is all normal and will disappear within a week without leaving a trace. You do not need to contact us.

Photo: Small pustules during the absorption of sutures 3-4 weeks after surgery:

It takes one month for the wound to heal by 70 % and 6 months to heal by 100 %. This is why any further surgery should be planned earliest 6 months after the last surgery.

This means that we should avoid any trauma to the penis for one month, use 2 pampers or sport protection for one month. Also: swimming, bathing, sport should be postponed for one month after surgery

After one month, the wound is stable and the child can lead a completely normal life (please note other recommendations for adults).

However, complete healing takes about 6 months after surgery.

The new urethra is made of your son’s own skin and fascia with normal blood vessels. It will grow normally as your son grows.

Our standard protocol is that the parents send an e-mail one month after surgery to report how is the healing of the operation. The first routine post-operative examination is 3 month after surgery by the operating surgeon. We recommend to maintain regular follow up after 1, then 2, then every 3 / 5 years until puberty.

“My son had surgery for his hypospadias few weeks ago. Everything looked very nice untill the surgeon removed the catheter from his penis. I noticed that gradually less urine is coming out from the tip of the pensi and urine is coming out from another opening near where the original urine opening was. What is this ? Is this a fistula?”

Fistula is a tract or tunnel connecting between the urethra and the skin. Through this tunnel, urine comes out. The parents can recognise this easily when they see that urine comes out through more than one opening when the child is passing urine more than a month after surgery. During the first weeks after surgery, the wound has not healed and it is normal that urine may come out in between the sutures. The fistula may be single or multiple ( the parents may notice more than two streams of urine). The fistula normally appear 1 – 4 months after surgery. In about 5 % of cases. Fistula may appear years after surgery due to reaction to suture materials remaining in the penis after complete healing of wound.

Fistula after not successful hypospadias repair: